EDWARDSVILLE PHYSICIANS GROUP LLC (NPI# 1376014175) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376014175 |
| Entity Type | Organization |
| Organization Name | EDWARDSVILLE PHYSICIANS GROUP LLC |
| Practice Address |
441 South State Route 157 Suite 102 Edwardsville IL 62025-4012 |
| Practice Telephone | 6182542273 |
| Practice Fax Number | 6182548476 |
| Mailing Telephone | 6182542273 |
| Mailing Fax Number | 6182548476 |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2018-12-06 |
| Authorized Official Name | MICHAEL HARBISON (PRESIDENT/OWNER) |
| Authorized Official Telephone | 6182542273 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Street Address |
441 SOUTH STATE ROUTE 157 SUITE 102 |
| City | EDWARDSVILLE |
| State | IL |
| Zip Code | 62025-4012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619519535 | Anderson Surgery Center LLC | Clinic/Center | 3403 Anderson Healthcare Drive, Edwardsville, IL 62025 | 2019-10-11 |
| 1194376640 | Katharine Mcginnis D.m.d. P.C. | Dentist | 235 A. South Main St, Edwardsville, IL 62025 | 2019-09-26 |
| 1568925014 | Southern Illinois Pediatric Dentistry of Edwardsville | Dentist | 1419 Lewis Road, Suite 2, Edwardsville, IL 62025 | 2019-04-11 |
| 1902277031 | Amy Lynn Britt | Nurse Practitioner | 1188 South State Route 157, Edwardsville, IL 62025 | 2015-10-15 |
| 1730563230 | Jenna Dallman | Chiropractor | 3 Sunset Hills Professional Center, Suite 2, Edwardsville, IL 62025 | 2015-07-14 |
| 1861745218 | Srimannarayana Marella | Family Medicine | 6616 Center Grove Rd., Edwardsville, IL 62025 | 2012-10-23 |
| 1669722872 | Ican Clinic LLC | Chiropractor | 441 S State Route 157 Ste 2, Edwardsville, IL 62025 | 2012-09-14 |
| 1922371673 | Teresa Marie Garbett | Pharmacist | 2 Sunset Hills Executive Park Dr., Addiction Treatment Strategies, Edwardsville, IL 62025 | 2012-02-10 |
| 1831324342 | Krista Nicole Nelson | Podiatrist | 235 S Main St Ste B, Edwardsville, IL 62025 | 2009-05-28 |
| 1447415757 | Harvey H Breckner D.m.d.,m.s | Exclusive Provider Organization | 600 Country Club View Suite 4, Edwardsville, IL 62025 | 2008-07-25 |
| Find all providers in zip 62025 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003430166 | Conlan Joseph Pierce | Surgery | 601 W Park St, Urbana, IL 61801 | 2020-06-04 |
| 1376167809 | Francesco Bajani | Surgery | 664 N Dearborn St Apt 2f, Chicago, IL 60654-3848 | 2020-06-01 |
| 1972123099 | Andrea Liu | Surgery | 5841 S Maryland Ave Mc6040, Chicago, IL 60637-1443 | 2020-04-18 |
| 1750917183 | Alberto Maria Fratti | Surgery | 901 S Ashland Ave Apt 711, Chicago, IL 60607-4088 | 2020-03-17 |
| 1841845047 | Barijuve Surgical LLC | Surgery | 380 E Northwest Hwy Ste 200, Des Plaines, IL 60016-2274 | 2019-08-05 |
| 1164081782 | Sean Park | Surgery | 1739 Tudor Ln Unit 308, Northbrook, IL 60062-3778 | 2019-06-07 |
| 1316421324 | Erica Lester | Surgery | John H Stroger, 1969 Ogden Ave, Chicago, IL 60612 | 2018-09-17 |
| 1023513389 | Crystal Siyu Zhang | Surgery | 2160 S 1st Ave Bldg 3210, Maywood, IL 60153 | 2018-03-28 |
| 1376047381 | Richard Lawrence Nelson | Surgery | 1603 W. Taylor St., Room 983, Chicago, IL 60612-4394 | 2018-03-23 |
| 1700380029 | Alicia Roston | Surgery | 1900 W Polk St Fl 4, Chicago, IL 60612 | 2018-03-21 |
| Find all providers with the same taxonomy | ||||
| City | EDWARDSVILLE |
| Zip Code | 62025 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.